Provider Network Specialist jobs in Colorado
Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Specialist jobs
Senior Provider Network Contractor
- Colorado Access
-
Aurora, CO
CONTRACTOR
- Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP ) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, seven company paid holidays, work from home options (exceptions apply), an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a Senior Provider Network Contractor who can help shape our vision and support our mission. Here is what the position will look like. Negotiates complex provider agreements utilizing a variety of negotiation strategies and techniques with all provider types, with emphasis on developing strategic partnerships with facilities, health systems, integrated care delivery systems, physician hospital organizations, independent practice associations, individual providers and clinics, ancillary providers, FQHCs and other providers. . Maintains proficiency in current and proposed reimbursement methodologies for facility and professional contracts, contract language and provisions and organizational operations to assure contract offers can be implemented and effectively administered. Provides comprehensive management of the contracting process, including rate and language negotiations, and operational implementation. Works with contracted providers on contract interpretation and assists with operational and/or reimbursement issue resolution. Serves as the project lead and subject matter expert for one or more of the following: Development and revision of multiple contract templates for contract management system, in collaboration with the Director, and software vendor Fee schedule analysis Appropriate billing and coding for physical and behavioral health Serves as contract management system administrator as assigned Works with legal and other staff to resolve complex claims issues Provides financial and operational performance analysis of existing and pending Provider contracts. Provides guidance, support and direction to Managed Care Contractors and other department staff as needed. Participates in Lines of Business financial operational meetings as assigned by Director. What you will bring: Education: Bachelor’s degree in health administration, business administration or related field required with a Masters’ degree preferred. Any combination of education or experience may be substituted for education or experience. Experience: Five to eight years’ experience negotiating complex contracts with health care providers (e.g., hospitals, health systems, medical groups, clinics). Experience with strategic planning; development, revision and quality control of contract templates, contracting guidelines; determination of network adequacy and capacity standards and other policies and procedures Knowledge, Skills, and Abilities: Working knowledge of the various medical reimbursement platforms including the Resource Based Relative Value System, Diagnostic Related Groups, and Medicaid reimbursement required. Demonstrates support for the company’s mission, vision and values. Must have excellent negotiation skills and techniques and knowledge of current negotiation strategies. Position requires excellent written, verbal and public speaking communication skills. Requires training, project development and management skills. Advanced knowledge of managed care contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required. Knowledge of local health and community agencies and providers preferred. Strong attention to detail with ability to handle multiple tasks simultaneously required. Ability to deal with multiple levels of staff. Must be able to handle high volume workload. Ability to work independently with little direction and initiate work priorities. Must be proficient in MS-Office applications (Word, Excel, and Access). May be required to manage multiple priorities and projects with tight deadlines. Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving. Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization. Pay, Perks and Benefits at Colorado Access: The compensation for this position is $90,180.00 - $108,220.00 annually. The pay rate/salary is commensurate with experience. In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes: Medical, dental, vision insurance that starts the first day of the month following start date. Supplemental insurance such as critical illness and accidental injury. Health care and dependent care flexible spending account options. Employer-paid basic life insurance and AD&D (employee, spouse and dependent). Short-term and long-term disability coverage. Voluntary life insurance (employee, spouse, dependent). Paid time off Retirement plan Tuition reimbursement (based on eligibility). Annual bonus program (based on eligibility, requirements and performance). Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’ We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.
- 30 Days Ago
Entry Level Communications Specialist
- Seronda Network
-
Denver, CO
FULL_TIME
- Join Seronda Networks as an Entry Level Communications Specialist!About Us: At Seronda Networks, you'll find more than just a company that offers cutting-edge solutions. You'll find a place where you ...
- 12 Days Ago
Clinical Engineering Network Specialist
- CommonSpirit Health
-
Englewood, CO
FULL_TIME
- Overview* CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-base...
- 2 Days Ago
IT Specialist (Network)
- U.S. Department of Homeland Security
-
Colorado, CO
FULL_TIME
- Help HelpRequirementsConditions of EmploymentYou must possess U.S. Citizenship or be a U.S. National.You must have reached the minimum age (18) at the time of application.You must complete a favorable...
- 5 Days Ago
IT Network Specialist
- Canon City Schools
-
Cañon City, CO
FULL_TIME
- JobID: 1807 Position Type: Technology/Network Specialist Date Posted: 8/16/2023 Location: District-wide Start Date: ASAP, or as mutually agreed upon Position Type: Full-time, 261 days per year Locatio...
- 7 Days Ago
Network Audio Visual Specialist
- Ampcus, Inc
-
Aurora, CO
FULL_TIME
- 3 mon assignment; Shift: Days, weekends and evenings as needed for events; Float: No; Wkend: As needed; On Call: No Min Reqs: Bachelors, previous exp, Audio Visual specialist with event and video prod...
- 11 Days Ago
Provider Network Specialist jobs at Popular Companies
Network Engineer
- QinetiQ
-
Reston, VA
- Company Overview We are a world-class team of professionals who deliver next generation technology and products in robot...
- 6/11/2024 12:00:00 AM
Engineering - Network Engineer Mid
- Pyramid Consulting, Inc
-
Enon, OH
- Immediate need for a talented Engineering - Network Engineer Mid. This is a 12+ Months Contract opportunity with long-te...
- 6/11/2024 12:00:00 AM
Network Technician/Network Engineer/Network Support Engineer(NO C2C CANDIDATES considered)
- Sharp Decisions
-
Graham, NC
- Title : Network Technician/Network Engineer/Network Support Engineer(NO C2C CANDIDATES considered) Contract duration : 1...
- 6/10/2024 12:00:00 AM
Network Engineer
- Kinettix
-
Kahului, HI
- Job Description: Independent Contractor Contract to Hire Job Title: Network Technician Responsibilities: Work a minimum ...
- 6/9/2024 12:00:00 AM
Sr. Specialist Network Engineer
- IT
-
Phoenix, AZ
- Nestlé Information Technology is the digital arm of the world’s largest nutrition, health, and wellness company. With 15...
- 6/8/2024 12:00:00 AM
Network Engineer
- Raytheon Technologies
-
Sterling, VA
- Date Posted: 2024-02-06 Country: United States of America Location: VA543: 22270 Pacific Blvd, Dulles 22270 Pacific Boul...
- 6/8/2024 12:00:00 AM
Network Engineer
- Apex Systems
-
Sumter, SC
- Title of Position: Network Technician Location (city & campus): Sumter, SC (Shaw AFB) Contract Length: 6 month Contract ...
- 6/7/2024 12:00:00 AM
Network Engineer
- Leidos
-
Norfolk, VA
- Description Leidos is a FORTUNE 500 company bringing a mix of innovative technology and sector expertise to customers in...
- 6/7/2024 12:00:00 AM
About Colorado
Colorado (/ˌkɒləˈrædoʊ, -ˈrɑːdoʊ/ (listen), other variants) is a state of the Western United States encompassing most of the southern Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains. It is the 8th most extensive and 21st most populous U.S. state. The estimated population of Colorado was 5,695,564 on July 1, 2018, an increase of 13.25% since the 2010 United States Census.
The state was named for the Colorado River, which early Spanish explorers named the Río Colorado for the ruddy silt the river carried from the mountains. The...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$59,906 to $89,565
Most Popular Cities in Colorado for Provider Network Specialist Jobs
What does a Provider Network Specialist do?
Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019